5. What is Esthetics?
Branch of Psychology
Esthetics is the study of the mind and
emotions in relation to the sense of beauty.
“A branch of philosophy dealing with the nature
of beautiful and with judgement concerning
with beauty”. (Oxford Dictionary)
6. DEFINITIONS
(GPT8)
1. Dental esthetics : the application of the
principles of esthetics to the natural or
artificial teeth and restorations.
2. Denture esthetics : the effect produced by a
dental prosthesis that affects the beauty
and attractiveness of the person.
Dr. Charles Pincus the Father of Esthetic
Dentistry
13. INTERPRETATION OF SEX
Expression of feminine
characters
• Roundness, smoothness and
softness
Expression of masculine
characters
Masculine form illustrates
cuboidal, hard, muscular ,
vigorous appearance which is
typical of men
John P. Frush and Roland D.Fisher
“How Dentogenic Restorations Interpret The
Sex Factor”
J. Prosthet. Dent., 1956; 6 : 160-172.
14. Female Male
• Incisal edges of the
max anterior teeth of
female follow the
curve of the lower lip.
• Distal surfaces of the
centrals are usually
rotated in posterior
direction
The max centrals and
canine are on a plane
parallel to the lip while
laterals are above the plane
Labial surfaces of centrals
are usually not rotated
Sex Interpretations by tooth positioning:
15. Mesial surface LI is often
seen in an anterior relation
to the distolabial surface of
the CI.
Distal surface is rotated
posteriorly to give softness
to smile
Mesial surface of LI is
hidden behind the distal
surface of CI .
Distal surface is rotated
very slightly in a
posterior direction by
giving hardness to the
smile
16. Distal surfaces of the
canines are rotated in
posterior direction ..mesial
third of labial surface is
exposed when viewed
from front
Rotated less in posterior
direction ….the mesial two
third of the labial surface is
exposed
17. INTERPRETATION OF PERSONALITY
FACTOR
.
.
fragile, frail, the opposite of robust
normal, moderately robust, healthy and of
intelligent appearance.
meaning opposite of delicate; hard and
aggressive in appearance, muscular type
John P. Frush and Roland D. Fisher
“How Dentogenic Interprets the Personality
Factor” J. Prosthet. Dent., 1956; 6 : 441-449.
18. PERSONALITY AND MOLD CONSIDERATION
youthful, good looking “model” type
of patient.
“coarse” and would be adaptable to
ample-bodied, obese woman.
typically robust form hence indicated
for men.
Moderate vigorous Rugged vigorousMild vigorous
Temperamental theory – personality influences morphology of teeth
19. AGE
ABRASION
The sharp tip of the cuspid ,suggests youth,
and, as age increases, it should be judiciously shaped, not abruptly horizontally
flattened, but artistically ground so as to imply abrasion against opposing teeth.
This erosion imparted to the artificial tooth, by
careful grinding and polishing very effectively,
conveys the illusion of vigor and advanced age
EROSION
"softened" on the tips of the cusps to avoid
the appearance of recently erupted teeth.
grinding the incisal edges
removing the incisal enamel
John P. Frush and Roland D. Fisher
“The Age Factor in Dentogenics”
J. Prosthet. Dent., 1957; 7 : 5-13.
20. Characterization of anterior segment
Frush and Fisher
Sex, Age and Personality (SAP)
Rufenacht
Sexual type, Aggressivity and Personality
(SAP)
21. The depth grinding is done on the mesial surface of central
incisor only
Depth grinding accentuates the third
dimensional depth necessary
For the delicate look -less depth
grinding
-vigorous look-severe depth
Grinding
-Average looK-should be between
Delicate and vigrous
THE THIRD DIMENSION-DEPTH GRINDING
22. THE DYNASTHETIC INTERPRETATION
OF THE DENTOGENIC CONCEPT
Dynasthetic Theory:
• It is the secondary factor of a dentogenic restoration. Dynesthetics is
a compound word. The prefix “dyn” is the combining form from the
Greek word “dynamics”, meaning power.
John P. Frush and Roland D. Fisher
“The Dynesthetic Interpretation of
the Dentogenic Concept”
J. Prosthet. Dent., 1958; 8 : 558-581.
23. DYNESTHETIC TECHNIQUES
Techniques includes
• Shade selection
• Depth grinding
• Abrasion
• Identification of masculinity or femininity
• Embrasures and diastemas
• Buccal corridor
• Gum line denture base contouring and tissue stippling
It concerns with three important divisions of
denture fabrication. The tooth, its position,
and its matrix
Secondary factors of Dentogenics are called as dynesthetics
24. Esthetic principles
FUNDAMENTALS OF ESTHETICS
Principle of visual perception and their clinical
application to denture esthetics( Richard E
Lombardi , JPD .29:359-382, 1973.)
25. ESTHETIC PRINCIPLES:-
COMPOSITION:
The relationship between object made visible by
CONTRAST is called Composition.
Terminologies in our field of interest are
dental,facial and dentofacial composition.
Dentofacial composition
Dental composition
Contrast
visibility α contrast.
26. COHESIVE FORCES SEGREGATIVE FORCES
• Elements that tend to unify Opposite of cohesive forces
a composition
• A border is a cohesive force They provide variety in unity….
as well as arrangement of
elements in a definite
form or according to a
principle.
Naturalness =cohesive + segregate forces. variety to the
composition dynamic and interesting
27. UNITY OR ONENESS:
• The prime requisite of composition is unity.
• It gives different parts of the composition the effect of
the whole.
• STATIC UNITY DYNAMIC UNITY
- composed of irregular Plants and animals
and geometric shapes
E.g drops of water,snow
Flake crystals
- Is passive and inert Active,living and
(without motion) growing
28. • HOGARTHS line Of Beauty:
• Has long been considered an outstanding example of unity with variety.
• It is a line inscribed around a cone.
• The line is never the same at any point
along its course yet it never leaves the
surface of the cone.
• This is absolute unity with absolute variety.
neutral space appears evenly full of teeth,
when the patient smiles
Denture look
29. BALANCE:-
It can be defined as the stabilization resulting from
exact adjustment of opposing forces.
Our visual sense is used to maintain or induce
equilibrium-if not established leads to visual tension.
Because of induced forces unbalanced things
will look transitory, restless, unfinished,
accidental, temporary, aggravating, and tense
30. Structural map- the most stable position of the disc is in the center
The proper midline location is a must for stability
Because of induced forces unbalanced things look transitory, restless,
unfinished, accidental, temporary, aggravating, and tense.
Proposed structural map of tooth area the most
Stable position is at the intersection of the axes
And indicates the critical role of the midline
Improper midline A measured midline
Balanced things look permanent, stable, completed, planned, peaceful, and in repose,
because the visual tensions are eliminated.
31. SYMMETRY:
Itreferstoregularityinthearrangementofformandobject.(Furtwangler,1964)
• HORIZONTAL SYMMETRY RADIATING SYMMETRY
• Occurs when a design contains Is a result of design of an object
similar elements from left to extending from a central point and
right in a regular sequence the right and left side are mirror
images
• Is psychologically predictable and Represents segregating forces that
comfortable tends to be brings life and dynamism to a
monotonous composition
33. DOMINANCE:-
• Just as unity is the prime requisite for a good composition, dominance is
prime requisite for providing unity
• dominance provides
Static unity Dynamic unity
( monotonous) (vigorous)
Dominance
Prime requisite
unity
Prime requisite
composition
A weak dominance takes place when
Subsequent elements do not provide
Sufficient factors of contrast.
A strong dominance requires the
Presence of subsequent elements
Providing strong factors of contrast
34. LINES:-
It has been stated that many factors that have
been a part of structural or biologic beauty
depends on visualization of lines.
Parallel lines are most harmonious as they do
not exhibit conflict
Perpendicular suggest psychological relationship
and strong segregative forces
Various lines exists in dental
composition:
• occlusal plane
• incisal plane
• midline
• tooth direction
35. STRUCTURAL ESTHETIC COMPONENTS
1.Facial components
2. Components of smile
3. Dental components
4. Gingival components
Facial features
Tooth visibility
Lip line
Smile line
Upper lip curvature
Negative space
Smile symmetry
Dental midline
Golden rule
Axial alignment
Dental morphology
Contact points
Gingival morphology
Gingival contour
37. Bulging lip
Impression stage
Role of esthetics is to develop labial and
buccal borders so that they are not only
retentive but also support the lips and cheeks
properly.
Care must be taken not to over support
these structures with borders that are too
thick
38. ANTERIOR TOOTH POSITION
• Payne writes that, “teeth should be placed where they grew.”
Vertical tooth placement Horizontal tooth placement
Payne,contouring and positioning ,
new york 1973, medcom,pp 50- 54)
8-10mm anterior to the center of the incisive
papilla
line extending between the middle of the upper
cuspids in relation to the incisive fossa indicates
proper location of the anterior teeth.
39. HORIZONTAL TOOTH PLACEMENT WITH POSITION
RELATIVE TO THE LABIAL VESTIBULE
(
These surfaces of artificial teeth should be set at that position with
imaginary extension of the roots of these projected to a resorbed
anterior alveolus.
Hickey:esthetics of Anatomy,medcom,inc ,new york 64-
69,1973.)
The labial surface of natural anterior
teeth are found as far forward as the
reflection of labial vestibule.
40. B) TOOTH VISIBILITY:
It is more important for females than males as the average
exposure of teeth is twice in females as that of males.
AGE
Young Woman
3 mm below the lip line
Middle aged Woman
1.5 to 2 mm below the lipline
Older Woman
1 mm below the lip line
Young Man
2 mm below the lip line
Middle aged Man
1 mm below the lip line
Older Man
0 to 2 mm short of the lip line
41. SMILE COMPONENTS
A) LIP LINE - refers to height of the upper lip relative to the maxillary central incisors.
High lip line
Medium lip line
Low lip line
Anterior low
lip line
42. B) SMILE LINE line drawn along the edges of the four anterior maxillary
teeth that has to coincide or run parallel with the curvature
of the inner border of the lower lip
sharp curve is youthful
broader curve indicates older dental composition
45. D) NEGATIVE SPACE (buccal corridors)
Is the dark space that appears b/w jaws during
laughter and mouth opening.
Adequate restoration of the lateral negative spaces
will permit the characterization of the smile and
enhances personality.
The diminution of size and detail must occur
gradually to increase buccal corridor space.
46. • Similar to a painting. the anterior and lateral negative spaces
act as a border to the dental elements, with the lips
representing the picture frame.
• Anterior negative space is evident during both speech and
laughter. while bilateral negative spaces should be evident
during a relaxed smile.
.
• As the teeth passes posteriorly,the light is reduced and this gives a
gradually darker shade and therefore a smaller appearance.
47. • Closest one appear larger
• Other like structures are interposed inbetween size
reduction apper gradual
ILLUSION AND GRADATION
HOW TO RESTORE LATERAL NEGATIVE SPACE??
If two objects are of the same size,the lighter
one appears larger, this is principle of
illumination
48. DENTAL COMPONENTS
DENTAL MIDLINE
• Recommended protocol
a) Placing this midline precisely in
accordance with facial midline or in
the middle of the mouth using the
incisive papilla or labial frenum as
landmarks.
b) Never establish it in a precise midline
because it may contribute to an
artificial appearance.
An eccentric midline if not too exaggerated is
acceptable and may lend to the illusion of
natural dentition
49. To be able to give a certain mathematical representation of
beauty for numerically expressing the relationship of the various units
that combine to make a composition, the term Proportion is used.
PROPORTION
The relationship of the various units which
are associated with each other through a
certain repetitive mathematical factor is the
Repeated ratio.
51. B) Golden proportion
• Pythagoras in 530 BC
found a mathematical
solution for what was
perceived as beautiful
or ugly
• Golden Number,
represented by the
Greek symbol, ∆ [(∆5-1)
÷ 2].
• The reciprocal of ∆ is
0.618 termed the
Golden or Divine
Proportion.
Roman statues based on
golden proportion
0.618 + 1 = 1.618
1 + 1.618 = 2.618
1.618 + 2.618 = 4.236
1 x 1.618 = 1.618
1.618 x 1.618 = 2.618
2.618 x 1.618 = 4.236
1 / 0.618 = 1.618
1.618 / 0.618 = 2.618
2.618 / 0.618 = 4.236
52. Edwin I. Levin
“Dental esthetics and the golden proportion”. J. Prosthet. Dent., 1978; 40, 244-252.
53. The distance between the two medial
canthus of eye is in golden proportion
with the distance between two medial
canthi of an eye
Golden
proportion From
trichion to eye
& to chin
Medial canthus of eye
to nose & to chin
In the relaxed face, the lip line
divides the lower third of the
face into the Golden
Proportion
54. To create diversity and individuality, repeated or recurring
proportions are more significant than a specific ratio
the ratio for beauty of 0.618 signifies an ideal.
other ratios, e.g. 0.577 or 0.8 are also perceived as aesthetic, with
the provision that there is repetition in a given composition.
So Lombardi suggested a continuous proportion or repeated
proportion
The ratio of width established between central & lateral must be
used as we progress distally
55. Recurring esthetic dental proportion
Dentist may use a proportion of his choice
but it should remain consistent while
moving distally
More flexibility
RED proportion should be modified to fit
face, general body type of the patient
Golden proportion + repeated ratio = Recurring esthetic dental (RED) proportion
Daniel H. Ward
“Proportional smile design using the recurring
esthetic dental (RED) proportion”
Dental Clinics of North America, 2002; 143-153.
56. C) AXIAL ALIGNMENT
Mesial inclination tends to be
more pronounced from the
central incisors to the canines
Bilateral axial alignment of the
teeth of the posterior segment
responds to the phenomenon of
balance of lines around central
fulcrum.
57. GINGIVAL COMPONENTS
The location of the
gingival zenith in relation
to tooth axis is distal in the
maxillary central incisors
and canines and coincides
on lateral incisors
Short teeth made to
appear longer by
Moving the zenith point
apically
58. Frenula
• Wax labial frenum (b/w central incisors) and buccal frenula (b/w I and
II premolar) is placed with wax spatula.
• Labial frenum is usually narrow and thin at the margin whereas buccal
frenum is broad thick or fan shaped.
TECHNIQUES FOR CREATING NATURAL-
LOOKING DENTURES
59. Stippling& Scalloping
The surface of natural attached
gingiva shows stippling effect.
This stippled effect is produced on
the denture by the use of a stiff-
bristled tooth brush.
Scalloping should be over
accentuated according to the age
of the patient.
interdental papillae are left long and pointed for young patients and short and blunt
for older patients.
60. GingivalSulcus
• The production of a slight bulk of
gingival margin and minute break
between it and the teeth affords
natural appearance.
• The gingival sulcus is formed by
inserting the tip of a No:23
explorer between the tooth and
the wax, then carrying it mesio-
distally along the cervical end of
the tooth.
More facial tooth structure is exposed in aged
patients to represent the normal physiologic
gingival recession
61. In staining the denture base to simulate
natural tissue, three factors must be
considered.
Greater density of the soft tissue
found in lighter tissue
Deep red - are found in mucobuccal
fold, frenula, incisive papilla,
interdental papillae and the larger
rugae
Pale yellow - in root eminences and
the hard palate
Neutral Pink - which falls between
extremes of deep and pale color
tones
Cellular components
Vascularity
Thickness of soft tissues
62. Custom Denture Tinting Pound’s technique
stains are applied on the stone
investment surfaces before
packing is done.
All stains must be applied in
reverse order, the one
representing the outer
surface being applied first.
Color
characterization
may be done after
the denture has
been processed.
63. The Denture Tinting Chart
Denture tissue tinting chart with areas to be tinted and
shades selected
AG = Attached Gingiva
AM = Alveolar Mucosa
B = Blanched areas over
roots
F = Frenum Attachments
P = Papillae
Shade Light reddish
pink
Shade Reddish pink
Shade Pale pink
Shade Red stain
Shade Light reddish
pink
Light pink - H
Light red - F
Medium red - A
Purple - E
Brown - B
64. Attached gingiva and root eminences-lighter in color
Interdental papilla and unattached mucosa are darker in color
Close-up of esthetic dentures.
Full smile view of esthetic dentures
65. Classification of errors in dental esthetics
(LombardiR.E,JPD;32:501-513,1974)
• Inharmonious dentofacial ratio
A)Shade disharmony
B)Compositional incompatibility
1. static denture in dynamic mouth
2.Inharmonious strength or weakness of dental
composition compared to background features
a. Weak mouth with strong face
b. strong mouth with weak face
• Intrinsic dental disharmony
1. Space allocation error
1 Inadequate vertical space allocation
2 excessive vertical space allocation
3 excessive horizontal space allocation
2. Structural line errors
1 elevated occlusal plane
2 occlusal plane drops down posteriorly
3 asymmetrical occlusal plane
3. Unnatural lines
1 Reverse smiling line
2 unnatural axial inclination
3 cuspless posterior teeth
4 gradation errors
5 Age-Sex-Personality
disharmony
4. Single –line errors
1. Vertical deviation
2. Horizontal deviation
3. Line conflict
5. Imbalance
1. Midline errors
2.Imbalance of direction
3. Artifact error
4. Diastema error
66. Inharmonious dentofacial ratio
A) Shade disharmony
B) Compositional incompatibility
1. static denture in dynamic mouth
2.Inharmonious strength or weakness of dental composition compared
to background features
a. Weak mouth with strong face
b. strong mouth with weak face
A static denture
Cardinal sin against the principle of visual perception
67. Drawing looks incomplete there is not enough
mouth Same dental composition is too weak to
play its Proper role in the facial composition
because of The strength of other facial features
Weak tooth arrangement =disharmony
strong facial features
Strong dental composition against a weak background
features There is too much mouth
Strong tooth arrangement =disharmony
Weak facial features
68. This drawing seems complete the strong dental
Composition is harmonious with strength of other
Facial features
Strong tooth arrangement= harmony
Strong facial features
In this drawing weak dental composition Seems
harmonious because rest of the facial Features
are also weak. A harmonious Relationship of
all facial features exist, Because the weak
dental composition is seen Against the
background of weak facial features
Weak tooth arrangement = harmony
Weak facial features
69. Inadequate vertical length of
dentalComposition,
composition is unreal and
Lacking in esthetic qualities
Excessive vertical length,
narrowSpace filled to
overflowing
Excessive horizontal space
This is unnatural, primitive
Coarse, lacking in human
qualities
Intrinsic dental disharmony
Space allocation error
70. Occlusal plane drops down as it
progresses Posteriorly.
An unnatural and unesthetic result
Bilateral asymmetry of the
occlusal plane
Incisal edges form a curve
which is in Contrast to the
curve of the smiling line
Structural line errors
71. Single –line errors
1. Vertical deviation
2. Horizontal deviation
3. Line conflict
Imbalance
1. Midline errors
2.Imbalance of direction
3. Artifact error
4. Diastema error
Use of short posterior teeth destroys the
illusionOf gradual reduction in the size,
sin against the Principle of gradation
Raising or lowering of one adjacent
Line destroys the illusion
72. Direction of line must be balanced to
Avoid unplanned results
Placement of an artificial element o
Either side produce imbalance
A wide diastema divides the
composition, and elements are
not balanced
75. ESTHETICSAND ADVANCEDTECHNOLOGY
• COMPUTER IMAGING SYSTEMS
• The computer imaging system (CIS) has revolutionized
• diagnosis, treatment planning, and case presentation. Intraoral
• and extraoral images can be accessed, stored, and
• manipulated, creating "what-if' scenarios
• Patients see not only their current condition but also the
• possible results of various treatment plans
Computer-generated superimposed
measurements predict the final dimensions of the
teeth after proposed diastema closure.
76. ESTHETICSAND PSYCHOLOGY
• 1937 House classified patients into four typesbased upon
psychologic assessment
• The philosophic patient
• The exacting individual
• The indifferent patient
• The hysterical patient
• 1. The patient has an unrealistic esthetic
expectation that cannot be satisfied.
• 2. The patient expects that an esthetic
improvementwill remove or correct deep-
seated psychologic problems.
• 3. The patient is not satisfied with results
that are technically and esthetically correct-
in other words, the "it's not me"
phenomenon.
• 4. The patient is satisfied with the results,
but family and friends are not.
• 5. The patient does not wish to have
esthetics enhanced, and the dentist does.
The dentist should not promise
more than can be delivered. The dentist should be
sensitive to cues that the patients or those
accompanying thepatients reveal during the initial
examination and interviewprocess.
Developing a Trusting Relationship
Decision-Making Ability
Cooperation and Follow-Through
Abnormalities and Problem Patients(psychological)
78. References
Zarb,Bolender, Prosthodontic treatment for edentulous patients
.Twelfth edition
Sheldon Winkler, Essentials of complete denture
prosthodontics,second, edition 2000
Claude R. Rufenacht: Fundamentals of esthetics, Quintessence
Publishing Co , 1992
Edwin I Levin :Dental Esthetics and the golden proportion , Journal
of Prosthetic Dentistry . 40: 244-252 , 1978.
Richard E. Lambarde : The Principle of visual perception and clinical
application to denture esthetics , Journal of Prosthetic Dentistry .
29:359-381 ,1973.
John P. Frush, Ronald D Fisher :Introduction to Dentogenic
Restorations , Journal of Prosthetic Dentistry ,5:587-595,1955.
79. John P. Frush, Ronald D Fisher :The Dynesthetic
interpretation of Dentogenic concept, Journal of
Prosthetic Dentistry. 8:559-581, 1958.
D J Lamb: Appearance and Aesthetics in denture practice,
wright bristel, 1987.
Bernard levin; Impression for complete dentures,
Quintessence pub. co., 1984.
Michael waliszwski ; Restoring Dentate Appearance : A
Literature review for modern complete denture esthetics,
Journal of Prosthetic Dentistry , 93 ; 386-393, 2005.
Ascheim , Dale: Esthetic Dentistry , a clinical approach to
techniques and materials.2nd edition , Mosby 2001
Ronald E. Goldstein:Esthetics in Dentistry,second edition,
BC Decker 2002
Editor's Notes
the emphasis placed on Beauty & Health. Evry age group ppl now needs esthetics.
Dental esthetics & beauty of the smile are of being a prime importance the edentulous patient is no exception, yet creating a natural-appearing smile for this patient is very difficult to obtain.
The edentulous patient will no longer accept the straight line over the ridge denture esthetics of the past. The Dentists, not patients, must be educated that it does not have to be this way.
Scottish physiologist Charles bell (1774-1842) was quoted as remarking that the thought is to the word that the feeling is to the facial expression.
He pointed out in 1806 that a smile could convey a thousand different meanings, yet it is the most easily recognized expression. And because the mouth is one of the focal points of the face , it should come as no surprise that the smile plays a major role in how we perceive ourselves, as well as in the impressions we make on the people around us.
These 4 entities of life even though different, are highly related and inter-dependentAs tooth plays important role in all these entities our fabrication of complete denture prosthesis should be scientifically and psychologically based and esthetically pleasing
The word “esthetic” stems from the same Greek root, as “esthesia” meaning sensibility or sensation4
13th Century, the Chinese were practising restorative dentistry by covering teeth with thin pieces of gold, either to hold them in place, or for aesthetic reasons. People still do this after so many years.Teeth sharpening has been seen in many different places of the world, including Africa and BaliIn Bali, teeth were filed down because it was thought that the teeth represented anger, jealousy, and other similar negative emotions. n Mayan culture, the teeth were sharpened, and sometimes had designs carved into them, to distinguish those in the upper classes. Congo, the Upoto tribe has men file only teeth in the maxillary arch (the top arch), whereas women file both mandibular (bottom) and maxillary arches (top).
Dentogenic is a coined word meant to convey, in reference to prosthetic dentistry, exactly the same meaning as the suffix -genic imports to photograph in the word photogenic. According to Websters Dictionary “eminently suitable for production or reproduction”. In our word dentogenic, we seek to describe only such a denture as is eminently suitable, in that, for the wearer, the denture adds to person's charm, character, dignity or beauty in a fully expressive smile.
In 1936 Wilhem Zech, a master sculptor, had an idea that artificial dentures were something more than porcelain blades adaptable to an edentulous residual ridge.
Zech's father was a dentist, and it was for his father that he first began to produce teeth with something more than geometric design. Young Wilhelm Zech, realized that every bone in the human face, as well as throughout the human body, contributes to the total human personality. No less the teeth.
He ground and formed teeth, which by their configuration would depict distinct styles and types of personalities. The soft rounded feminine type; rugged, coarse masculine type. He changed the standard ovoid, square; and tapering concepts, and added artistic irregularity of surface unusual proximal formation, vigorous ridges and subtle body interpretations.
Frush and Fisher advocated use of appropriate molds for males and females rather than attempting to make a single mold work for both. Introduction of the influence of gender, personality and age on arranging anterior denture teeth was revolutionary in light of what was being practiced by the profession.
There are only two sexes immediately identifiable
Age can be easily separated into young, middle or elderly
Personality is a bit more complex, but, again it can be of three types i.e.,vigorous, medium and delicate.
A women is a woman from her finger tips to her smile and a man from his fists to his smiles4
A glance at the schematic feminine form is sufficient to illustrate the roundness, smoothness and softness that is typical of women.
The positions of the incisal edges, the prominence of gingival portions of the necks of the teeth, and the position of the body of the teeth reflect feminity and /or masculinity.
Maxillary central incisors are positioned approximately 7mm from the middle of the incisive papilla for females. Males have thinner and more muscular upper lip. Placement of their central incisors at a position 5 mm from the middle of the incisive papilla is an excellent starting point in achieving decreased lip support.
Arch form: round denotes feminity and squareness denotes masculinity.
The harmonious interrelationship between the shape of the arch, dental arch form and teeth (Nelson triad) has been used by many prosthodontists
Maxillary anterior teeth: in females, incisal edges follow the curve of the lower lip. In males, central incisors are on a horizontal plane parallel with the lip, the lateral incisors are above the plane, and the cuspids are on the plane.
Normally for mature males, the incisal edge is seen with the lip at rest. A middle-age man would have 1 mm of tooth visible below the lip at rest. For females it should be 2-3 mm.
The lateral incThe lateral incisor rotated to show its mesial surface, whether slightly overlapping the central incisor or not, gives softness or youthful coquettishness to the smile. By doing the reverse, that is, by rotating the lateral incisor mesially, the effect of the smile is hardened.
isors: They can also impart a quality of softness or hardness to the arrangement by their positions
Smaller lateral incisors with rounded incisal angles appear more feminine than longer ones.
Out at cervical end, as seen from the front.
2) Rotated to show the mesial face.
3) Almost vertical as seen from the side.
Prominent cuspid eminence gives to the cuspid greater importance and therefore gives to the smile a vigorous appearance more suitable for masculine sex.
Cuspid in females, when viewed from the front distal surfaces rotated in posterior direction therefore mesial surface is exposed. In males it is rotated less resulting in exposure of mesial one third, when viewed from front.
Frequently the main concern in arranging the first bicuspid in a maxillary denture for a female patient is esthetics rather than function, because a women usually exposes more maxillary teeth than man when speaking, smiling or laughing.
We wonder how popular television and movies or even magazines would be if all people were reduced to one male and one female type. So regardless of whether this face and figure of ours are our fame and fortune, nature has endowed us with something for more important, the dignity and satisfaction of being an individual with a personality of our own6.
Interpretation of personality factor depends on our manipulation of tooth shapes (molds) tooth colors, tooth position, and the matrix (visible denture base).
Personality and mold consideration:
Compared to age and sex, personality is most difficult to determine,
Wilhelm Zech has given us his concepts of the molds in the personality spectrum as in vigorous, medium and delicate categories.
personality spectrum, which has color-band or vertical rainbow hues extending from red to violet
The rugged, male extrovert could only fit into the bold, red end of the spectrum. The shrinking violet type female could only belong at the right end of the scale and the medium, normal type, male or female, would fit somewhere in between.
The three divisions of personality spectrum are;
Delicate type (green to violet band) - 5%
Meaning fragile,fraile, the opposite of robust.
Medium type (orange to yellow band) - 80%
Meaning normal, moderately robust, healthy and of intelligent appearance.
The vigorous type (red to purple) - 15%
Meaning the opposite of delicate, hard and aggressive in appearance, the extreme male animal.
Most vigorous patients are men and most delicate patients are women.
Our illustrations of the analogy between sculptured artistry in animals (Fig. 4) and the sculptured effect is possible in artificial teeth.
a) Sculptured Giraffe delicate contours
b) Sculptured Llama represents Medium character or personality and
Sculptured Bull represents vigorous type
, "Age is the most terrible misfortune that can happen to any man other evils will mend, this is everyday getting worse".
With the advancing age one can see changes in face, hair, skin texture, strenght… in every aspect..as wel as in teeth
The dignity of advancing age must be appropriately portrayed in the denture by careful tooth color selection and by mold refinement, also by the intervention of such characterization, as would be fitting for the personality and sex of the patient.
They are smoother.
2. They are darker (i.e., not as bright, lower
value).
3. They have a higher saturation (higher
chroma).
4. They are shorter incisally (less tooth shows
when the patient is smiling).
5. They are longer gingivally (although they may
be shorter incisally).
6. They exhibit more wear, even on incisal edges
with small incisal embrasures.
7. They have wider, more open gingival embrasures.
8. They are more characterized.Color selection: Lighter shades for young people and darker shades for older ones.
Mold refinement: The mamelons are present at the incisal edge of the central and lateral incisors. The cuspid presents a pointed tip, which is very sharp in appearance. The mamelon is soon abraded
. Later the sharp tip of the cuspid wears down to a more mature form. Teeth abrade with age. Central and lateral incisors abrade in straight line and cuspids abrade in a curve. This results in flattening of the arch
Age in the Matrix:
Periodontal changes that may occur with age are Gingival inflammation, edema with loss of stippling, recession due to loss of attachment. Advancing age can be indicated appropriately by shortening of the papillae, and by raising the gingival gum line to suggest recession.These changes can be reproduced in complete dentures and will help to improve the esthetics, especially if the gingival tissues and flanges are visible on speaking or smiling widely.
keeping in mind the influence of the sex and age factors When we incorporate the personality factor in esthetics
Frush and Fisher sap concepts showed progressive wear with advancement of age of anterior teeth with length of the maxillary central incisor considered constant throughout life.
According to Rufenacht tooth wear stressed functional disturbances of an individual
The “denture look” is mostly due to the flat appearance of the artificial upper anterior teeth; their lack of depth or of 'body'. It gives “bridge-facing” look to the denture. With a soft stone, the mesial – labial line angle of the central incisor is ground in a definite and flat cut, following the same curve as the mesial contour of the tooth in order to move the deepest visible point of the tooth further lingually. After this cut has been made, a careful rounding and smoothing of the sharp angle made by the stone must be accomplished, and perfect polish must be given to the ground surface so that it cannot be distinguishes from a surface produced by a glaze in a porcelain furnace.
We always need that feeling of depth, that third dimension, for realism. It is used for women (spheroid shape) as well as for men (cuboid shape). A flat, thin, narrow tooth is delicate looking and fits delicate women (little depth grinding). A thick, bony, big sized tooth, heavily carved on its labial face, is vigorous and to be used exclusively for men (severe depth grinding).
For the average patient, a healthy woman or a less vigorous man, depth grinding will be an average
The dentogenic therapy of esthetics is a basic esthetic concept for all phases of dentistry where appearance is a factor. It is with a conscious consideration of these patients 'constants' (SPA), that the dentist has learned to apply his knowledge with the most effectiveness8.
Dynesthetic techniques are not to be confused with dentogenic procedure. The dynesthetic techniques are rules which concern, the three important divisions of denture fabrication; 1)the tooth, 2) the position and 3) its matrix (visible denture base).
The word dynesthetic is used with the meaning of dynamics applied to the fine arts. In this application, it means producing the effect of movement or progression
). In dynamic beauty, the beauty is present and recognized in movement
The dynesthetic techniques are rules, which concern the three important divisions of denture fabrication: (1) the tooth, (2) its position, and (3) its matrix (visible denture base).
DYNESTHETIC OUTLINE:
A dentogenic restoration is fabricated within the framework of dynesthetic procedure. Any compromise or short cuts will make the finished restoration more like an ordinary denture.
He studied the science and principles of visual perception and their influence in creating intense vitality, beauty and realism on denture prosthesis.
He discussed principles of esthetics such as unity, composition, dominance, proportion, illusion in denture esthetics.
Essential beauty may be the invisible background of the physically perceptive, concrete beauty that presents constant equilibrium of shapes and colors observed in any geographic location.
The physiologic property of eye is vision.Vision is possible if eye can differentiate.Which is possible only if there is contrast.Increase in visibility is proportional to increase in contrast.
Naturalness has combination of cohesive and segregate forces. A proper mix of segregate and cohesive forces adds variety to the composition making it more dynamic and interesting.
Unity between different parts of the face, and teeth is essential to give the effect of oneness or wholeness to the dento-facial composition
Unity with variety (segregating forces) is necessary to make design effective
The elements must be bound together in an interesting manner
A common error in the construction of the complete denture is that, this neutral space appears evenly full of teeth, when the patient smiles
To relieve tension or to reestablish balance 2 possibilities are left to the operator /viewer:-
1) move the causative element towards the line of force until the magnitude of visual tension is totally relieved.
2) introduce an opposite element in the line of force to promote equilibrium
Horizontal symmetry occurs when a design contains similar elements from
left to right in a regular sequence.
It is and can be totally differentiated from balance in the sense that in balance things that are farther from the center grow in importance and weight..
But in case of symmetry all the elements are alike with references to there position in relation to a central point.
In a dento-facial composition radiating symmetry of the teeth is more esthetically appealing and is associated with youthfulness while horizontal symmetry is less appealing and is associated with aging
The amount of dominance to be given to the mouth by the dental composition depends on patients personality and strength of background facial features
The dominance of dental composition is increased by increasing mold size, using lighter teeth, placing the teeth farther anteriorly and increasing the exposed gingivoincisal length, are all method of increasing visibility.
For a patient with soft personality , dominance may be produced by minimizing these factors and for a patient of strong personality all or part of the above features may be restored.
Equal lines represent important cohesive forces where as crossed lines have the stronger connotation of the segregative forces.
The principle of line: horizontal lines created by cervical staining, texturing, white hypoplastic lines, and
straight incisal edges create the illusion of width; vertical lines
created by narrowing the face of the tooth, carving the incisal
edges to slope cervically, and deepening the incisal embrasures
create the illusion of length. Thesesame concepts apply for clothing and makeup. Individuals
wearing clothing with vertical lines appear thinner.
Conversely, horizontal stripes accentuate width. To"lengthen" and "slim" the nose with cosmetics, a light
highlighter is applied in a vertical line down the centerbridge of the nose. Then a darker contour shade of
makeup is applied on each side of the nose to make thatarea recede.9
esthetics of anatomy are properly developed when the anterior teeth and the denture base material hold the facial muscles at their proper physiologic length. esthetics of anatomy are closely interrelated with physiology.
Muscles the prosthodontist is particularly concerned with are
Orbicularis oris,
Zygomatic triangularis and
Buccinator muscle.
An artist in his creation of facial form makes use of established guidelines….
The dentist as an artist also has to consider a number of established guidelines and make use of available references to orient his creation.
The references can be classified as:
Horizontal
Vertical
Sagittal and
Phonetic
Horizontal references
Interpupillary line – Helps to evaluate orientation of:
Incisal plane
Gingival margin and
Maxilla
2) Commissural line
3) Occlusal line
Vertical References
Facial midline
Axial inclination – Is the direction of the anterior teeth in relation to the central midline. All anterior teeth have a definite mesial inclination. Deviation beyond the point of equilibrium can cause visual tension.
Sagittal reference
E-line or esthetic line(Ricketts,1957) – imaginary line connecting the tip of the nose to the most prominent portion of the chin on the profile.
Ideally upper lip is 1-2mm behind the lower lip and lower lip is 2-3mm behind the E-line.
Muscles the prosthodontist is particularly concerned with are
Orbicularis oris,
Zygomatic triangularis and
Buccinator muscle.
3 factors effect the face in repositioning the orbicularis oris muscle with complete denture:
Thickness of labial flanges of both dentures.
Antero-posterior position of the anterior teeth.
Amount of separation between mandible and maxilla
Space between the anterior teeth and the tongue blade indicates that the teeth are positioned too far posteriorly.
Proper location of the labial surfaces of the anterior teeth in relation to the labial flange of the trial denture base as indicated by the tongue blade.
The aesthetic zone is delimited by the lip perimeter.
The amount of tooth surface and gingival tissue displayed
during speech and smiling is determined by
the tonus of the orofacial muscles that influence the
movement of the upper lip (66). The average smile
is described as the position of the lip showing 75% to
100% of the maxillary incisor and the interproximal
gingiva (107).High : reveals the total cervicoincisal length of the maxillary anterior teeth and a contiguous band of gingiva
Average smile-reveals 75% to 100% of the maxillary anterior teeth and the interproximal gingiva only.
Low smile- displays less than 75% of the anterior teeth.
A pleasant smile is an expression of joy
The relationship exists between teeth and lips during smile and its harmonious integration in facial composition
Passive
Active
Laugh
Slight parting of the lips showing incisal portion of the anterior teeth
Shows more teeth, some gingiva and negative space with lips slightly stretched at the corner
Maximum exposure of teeth and gums in an enlarged smile window
buccal corridor alters the light thus illuminationand enhances esthetics based on principles of illusion
If two like structrures are placed at different distances on a line from the viewer,the closest one to the viewer will appear larger.
If other like structures are interposed between these two , the size reduction will appear to be a gradual one, from the size of that of the closest one to that of the farthest.
Lateral negative space also in golden proportion to half the width of the anterior segment.
The rule of thirds divides the face vertically into three approximately equal segments. The superior border of the face is the trichion. The junction between the upper and middle third is the nasion, the junction of middle and lower third is subnasalae. The inferior border is the menton. If lower third is divided into thirds, the incisal plane is at the junction of the upper and middle thirds.
Proportionate relationships provide qualitative value of esthetic appraisal.
In its simplest form it is the proportion between the larger part and smaller part.
When ratio between B and A is in the golden proportion, then B is 1.618 times larger than A.
The concept of ‘as viewed from the frontal’ is essential for Golden proportion.
The space between the bottom of the nose and the bottom of the chin is divided by the lip line into a "chin to lip line" (the larger part) and a smaller part the "lip line to under the nose"
Strict adherence to golden rule would result in excessive narrowness of the maxillary arch & compression of the lateral segments
Patients want customization rather than standardization
For the same width of central incisor different widths of lateral incisors is used. Fig A has a lateral incisor that is 80% the width of the central incisor and canine is 80% the width of the lateral incisor. In this case, canine is wide and gives the appearance of denture teeth arranged flatly side by side. In fig. B 70% RED proportion is used. In fig C Golden proportion is used.
The ratio which is established between the width of central and lateral incisors is continued in the ratio of the placement of the remaining teeth. This is the use of repeated ratio.
Rather than being locked into using the 62% proportion,
the dentist can use the proportion of his /her own.
The use of the RED gives greater flexibility.
Zenith points are the most apical point of the clinical crowns, which are the height of contour. There position are dictated by:
Root form anatomy.
CEJ.
Osseous crest, where gingiva is scalloped the most.
They are generally located just distal to a line drawn vertically through the middle of each anterior tooth
.
The lateral incisors are one exception as their zenith point are placed more centrally or on the midline of the tooth.
Importance of zenith point – when closing diastemas or changing the mesial or distal tilt position of the tooth.
(These are e.g. of moving zenith points horizontally)
In cases where teeth needs to be shown longer or more taper at the gingival 1/3rd Zenith point can be moved apically
Therefore, zenith point can enhance:
Perception of tooth axis.
Length. By horizontal & vertical axis
Gingival shapes
Interdental papilla must be convex in all directions always for swlf cleansing property
Ponds-----The colors were applied with a brush in stages, starting with the I
nterdental papilla and extending toward the peripheral border or mucosal tissue where the color would be more vascular or reddish
Tints should be placed in eye dropper bottles with the glass droppers turned upside down to control the placement of the tints.
Kemnitzer technique
Here staining is done after packing.
Cellophane trial pack sheets are placed between teeth and the acrylic resin being packed, and not between the cast and the resin.
A neutral shade of pale pink color is used for packing
Disadvantages:
It is impossible to predict the results of application since the effect of adding the stains cannot be observed.
The repeated addition of the monomer directly against the separating medium may result in the investment adhering to the base acrylic resin when the denture is deflasked.
Characterization should be visible but
not glaringly obvious. Some applications may be so subtle
that one is barely aware of the effect.
In the maxillary arch, implants are placed in the canine
locations or posteriorly, if possible (Fig. 16-39).
This alsoallows the restorative dentist flexibility in properly placing pontics for optimal lip support, phonetics, and esthetics.
This is particularly necessary in the case of considerable resorption of the maxillary anterior region.
Insufficient lip support.
Drooping of the corners of the mouth.
Reduction in the visible part of vermillion border.
Wrinkles above the vermillion border.
Deepening of nasolabial grooves and reduction in the prominence of philtrum.
In this instance, the final restoration can be placed near the anterior border of the residual maxillary ridge to provide
proper lip support and optimal esthetics (Fig. 16-40).
Esthetically, implant-retained restorations in the maxillary anterior region may be complicated by the space
needed for the restorative hardware and for proper oral hy giene. These considerations may affect speech as well as
esthetics, especially in severely resorbed ridges.
The use of an overdenture provides the option of extending the labial flange to provide for additional
lip support. This will maximize esthetics and facial contours.
Also avialble for rpd nd cd… no pics
Also cad cam made dentures are advancements in estetiic dentistry
Although House's classification furnishes guidelines
for diagnosing patients, the psychologic assessment of a
patient goes beyond simple categorization.
Not all problems can be anticipated and prevented.
The dentist must think about the type of problems faced
in an esthetic dental practice and consider an approach
to dealing with these problems.
There are two worlds: the world we can measure with line and rule, and the world that we feel with our hearts and imagination.
The dynesthetic and dentogenic concept, when applied, provides a more natural, harmonious prosthesis, which not only is desired by patients, but also is a quality of care they deserve. Outstanding esthetics can be achieved by simple guidelines; using tooth molds specifically sculpted for males and females, arranging prosthetic teeth to correspond the sex, personality and age and sculpting the matrix (visible denture base) with more natural contours.
Every patient cannot afford the expense of full mouth or implant reconstruction in an effort to avoid complete dentures. Should they become edentulous? By employing dentogenic principles and concepts, it is possible to restore their dignity and individuality.